Want another baby but having difficulty getting pregnant this time around? We talked to Dr. Gregorio Pastorfide, an obstetrician-gynecologist who is a pioneer of in vitro fertilization in the country and a key opinion leader in the field of infertility and trophoblastic diseases, to shed light on your questions on infertility and secondary infertility:

1. “If we have trouble getting pregnant, when should we consult a fertility expert?” Most of the patients I see are couples who have been unsuccessful in achieving pregnancy after at least a year of unprotected intercourse. These patients have been treated and observed by other obstetrician-gynecologists who refer them to me. This is applicable to younger patients. Because achieving a successful pregnancy is more difficult when the patient is 35 years old and above, we start the infertility treatment much earlier (around six months ahead).

2. “My husband and I have one child and we're trying to have one more, but we’re still not pregnant. Have I become infertile?”Secondary infertility is a condition wherein a patient who has delivered a child or several children is trying to get pregnant again but has been having difficulty for at least a year. Either she and her partner are not using any kind of contraception or they have been separated for a long period. Secondary infertility is essentially the same as primary infertility (the patient has never been pregnant); the only difference is that the patient has had children before.

There are several possible causes of secondary infertility, such as pelvic infections, subsequent tubal problems following a pelvic infection, new growths or tumors developing in the pelvic area, or the man having the adult onset of mumps, which can affect his sperm. It's always a case-to-case basis because infertility doesn't have just one cause. The same things that can cause primary infertility can also cause secondary infertility.

3. “My doc says my hubby should get checked, too, but he insists he's fine. How can I convince him?”Proper education and counseling should convince your husband to get checked, too. You can mention to him that you’d be subjected to so many costly tests, only to maybe find out that he is the one with the problem. Inform your husband that he needs to take only one simple and inexpensive test — and that is enough to rule out a possible cause.

Most of the time, men are scared to find out that they’re the ones who have a problem, especially because management [of a male fertility problem] can be difficult. The “macho effect” is always there. But there are many ways experts can help him manage his problem, if any, for you to achieve a successful pregnancy. Also, there is a higher chance of getting pregnant faster if both husband and wife cooperate.

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4. “Do the pills, IUD, or injectibles lessen my chances of getting pregnant after taking or having them?”When you stop taking the pill — and there have been studies on this — your chances of getting pregnant are the same as when you weren't taking it. Some even get pregnant the moment they discontinue it.

When you have an IUD, you have a slightly increased chance of getting an infection. If you do develop an infection because of an IUD, it may affect your fertility later on. Uneventful use of the IUD or the pill, however, will not affect your chances of getting pregnant again.

The injectible is a different story. If your ovaries were severely affected because of too much inhibition, then it might take a while for your hormones, ovulation, and menstrual cycle to go back to their natural state.

The best contraceptive still really depends on the patient's condition. For example, a woman who is predisposed to pulmonary embolism and thrombotic diseases definitely cannot take oral contraceptives. If the woman is very young and hasn't gotten pregnant, then maybe an IUD isn't the best option for her. Every contraceptive method has its own advantages and disadvantages. Consult a doctor when deciding on this as he can best explain them to you.

5. “I'm anxious about needles and laboratories. How many tests will be done and how long would they take? Also, how much would the tests cost us?”There are several tests for the woman depending on what’s needed, and most of them are done in relation to her menstrual cycle. If you need to redo some tests because you missed a specific window in the menstrual cycle, then you would have to wait for the next one. For the man, a sperm collection is needed, and if there are other problems, that's only the time that he will be required to do other procedures. The length of time really depends on how religious the couple is in following up, but generally, tests are done in a span of two to four months.

If the patient is below 35 years old, medication would be minimal. If the patient is older, more medication would be required.The greatest expenses are the drugs, and the medicine is more expensive here compared with other Asian countries. A ballpark figure for costs would be about P300,000 to P500,000.

6. “Which one has a higher rate of successful pregnancy: in vitro fertilization (IVF) or artificial insemination?”IVF was initially intended for patients whose fallopian tubes are closed, so artificial insemination isn't an option for them. There are several indications for IVF now, not just because of the woman's age or condition but also because of the man's condition. If a couple has been trying to get pregnant via artificial insemination and has failed several times, then IVF becomes an option. However, if the patient is nearing menopause, it may be better to do IVF right away.

There are higher chances of getting pregnant with IVF because it can already rule out many factors. In artificial insemination, the man’s sperm is collected, prepared, and concentrated before injecting it into the woman's uterus. In doing so, the seminal fluid is more active because you take out other factors that could be causing the problem. But because you'd still have to wait and see if the sperm would travel to the fallopian tube and meet the egg, you won't know immediately if fertilization occured. With IVF, the fertilization is done in a laboratory and you’d know right away whether an embryo was produced or not.